31525 and 31622


Detroit Chapter
Best answers
Can anyone tell me when it is appropriate to bill for a broncho and laryngoscopy procedures? What should the documentation say to support medical necessity?


Best answers
Most of the time that's not a billable combination. Dr must document the usage of two different types of scopes and the medical necessity for using two. If you can justify coding both, use -59 on the 31525(non-facility).

See the NCCI Policy Manual Chapter 5

C. Respiratory System

3. When a diagnostic or surgical endoscopy of the respiratory system is performed, it is a standard of practice to evaluate the access regions. A separate HCPCS/CPT code should not be reported for this evaluation of the access regions. For example, if an endoscopic anterior ethmoidectomy is performed, a diagnostic nasal endoscopy should not be reported separately simply because the approach to the ethmoid sinus is transnasal. Similarly, fiberoptic bronchoscopy routinely includes an examination of the nasal cavity, pharynx, and larynx. A separate HCPCS/CPT code should not be reported with the bronchoscopy HCPCS/CPT code for this latter examination whether it is limited (“cursory”) or complete.

If medically reasonable and necessary endoscopic procedures are performed on two regions of the respiratory system with different types of endoscopes, both procedures may be separately reportable. For example, if a patient requires diagnostic bronchoscopy for a lung mass with a fiberoptic bronchoscope and a separate laryngoscopy for a laryngeal mass with a fiberoptic laryngoscope at the same patient encounter, HCPCS/CPT codes for both procedures may be reported separately. It must be medically reasonable and necessary to utilize two separate endoscopes to report both codes.